Extensive spinal epidural hematoma - An uncommon entity following cervical chiropractic manipulation

Introduction: Spinal epidural hematoma is a rare complication after chiropractical manipulation. In the literature, only three cases have been reported, which all necessitated surgical treatment. Case: A 27-year-old woman was treated with cervical chiropractical manipulation (C5/6) and facet joint infiltration. 10 minutes later the patient presented signs of intracranial pressure with nausea, vertigo, headache and vomiting. The magnetic resonance imaging of the spine demonstrated an epidural hematoma extending from the cervical to the sacral spine. As the patient had no sensible or motor deficits and recovered quickly, surgical treatment was not necessary. A few days later the patient had a complete persisting remission of symptoms. Conclusion: If neurological deficits occur after chiropractical manipulation, a spinal epidural hematoma should be considered to provide adequate therapy without delay. The current case report shows an unusual expansion of the hematoma which has not described so far after chiropractical manipulation. But, in contrast to the three cases reported before, a surgical intervention was not necessary.